Spalletta - Associazione Italiana di Psicogeriatria

Apatia e Depressione

nelle Patologie Associate

all’Invecchiamento

Gianfranco Spalletta

IRCCS Fondazione Santa Lucia

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Int. Psychogeriatrics 2010

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CLUSTERIZZAZIONE DEI BPSD

(Lawlor et al, 2001)

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APATIA E DEPRESSIONE

Sintomi

Apatia Comuni Depressione

Risposta emotiva appiattita Diminuzione dell’interesse Disforia

Indifferenza Rallentamento psicomotorio Ideazione suicidaria

Riduzione delle attività sociali Faticabilità/Ipersonnia Autocritica

Diminuzione dell’iniziativa Ridotto insight Sensi di colpa

Ridotta persistenza (motivazione) Pessimismo

Hopelessness

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Am J Geriatr Psychiatry 2009

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Anziani istituzionalizzati non dementi

Factor 1:

Depression

Factor 2:

Hyperactiviy

Factor 3:

Psychosis

Factor 4:

Mania

Factor 5:

Apathy

Delusions .072 .115 .873 .064 .053

Hallucinations -.020 .006 .878 .063 -.018

Agitation .263 .768 .186 .243 .077

Depression .775 .118 .155 -.056 .365

Anxiety .781 .052 -.020 .166 .197

Euphoria -.002 .075 .105 .836 -.082

Apathy .270 .163 .057 -.117 .780

Disinhibition .067 .090 .026 .840 .254

Irritability .276 .792 .100 .104 -.106

Aberrant motor behavior -.007 .023 -.015 .294 .745

Nighttime behavior disturbances .737 .190 -.026 -.042 -.174

Appetite and eating abnormalities -.105 .699 -.094 -.090 .311

Int psychogeriatrics, 2010

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Proportion of people with different NPI syndromes

undergoing specific psychotropic treatment.

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Kaplein Meyer cumulative survival curves.

Progression to dementia in MCI patients with depression or

apathy

Depression

Apathy

J Alzheimer Dis 2010

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Risk of developing AD over up to four years in MCI patients with depression or apathy.

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Diffusion Tensor Imaging

Ultra-structure damage

"MD"

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Mean Diffusivity (MD) Correlates of

Apathy in 20 Amnestic MCI Patients

Panel A: shows the Uncinate Fasciculus

(UF) at Talairach Tournox coordinates

(x=31; and from y=10 to y=8).

Panel B: shows the Inferior Longitudinal

Fasciculus (ILF) at Talairach Tournox

coordinates (x=42; from y=-2 to y=-4).

Panel C: shows the Middle Longitudinal

Fasciculus (MLF) at Talairach Tournox

coordinates (x=47; from y=-8 to y=-10).

Panel D: shows the medial white matter area

including parathalamic white matter (y=-30),

fornix (y=-32), and posterior cingulum (y=-34).

Talairach Tournox coordinates (x=15; from y=-

30 to y=-34).

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Diffusion Tensor Imaging

Loss of Anisotropy

"FA"

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Microstruttura cerebrale

Soggetti sani di sesso femminile

Fractional anisotropy

Mean Diffusivity

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Change in MMSE performance between baseline and one-year follow-up

in patients with and without baseline depression,

stratified by follow-up depression status

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Cognitive outcome (change in MMSE between baseline and follow-up)

in 51 patients with baseline depression

according to antidepressant medication use and depression status at follow-up

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CONCLUSIONI

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APATIA E DEPRESSIONE

Sintomi

Apatia Comuni Depressione

Risposta emotiva appiattita Diminuzione dell’interesse Disforia

Indifferenza Rallentamento psicomotorio Ideazione suicidaria

Riduzione delle attività sociali Faticabilità/Ipersonnia Autocritica

Diminuzione dell’iniziativa Ridotto insight Sensi di colpa

Ridotta persistenza (motivazione) Pessimismo

Hopelessness